男性慢性肾脏病合并性功能障碍的研究现状

性功能障碍在男性慢性肾脏病(CKD)患者的发病率较普通男性高,其中勃起功能障碍是最常见的临床表现。内分泌系统功能失调与男性CKD患者性功能障碍的发生密切相关,主要包括下丘脑-垂体-性腺轴的紊乱和高泌乳素血症。同时,血管、神经系统、心理、微量元素、药物等因素也参与了发病过程。目前,主要通过量表评估、临床表现及专科检查对男性CKD患者的性功能障碍进行诊断。治疗上以纠正内分泌系统功能紊乱为基础,包括重组人促红细胞生成素、1,25-(OH)_2 D3、溴隐亭、氯沙坦、锌制剂等药物治疗及肾移植治疗。此外,5型磷酸二酯酶抑制剂等性功能障碍的常规治疗方法可作为补充。本文将从男性CKD合并性功能障碍的危险因素、病因、病理生理、诊断及治疗等方面的研究现状进行综述。     

脊髓型颈椎病对男性勃起功能影响的临床分析

目的:探讨脊髓型颈椎病对男性性功能的影响及手术后性功能的恢复情况。方法:通过前瞻性随访22例男性患者,均因脊髓型颈椎病伴有性功能障碍接受手术治疗,术后随访平均16个月。手术前后的神经功能按照JOA评分标准,性功能评定采用勃起功能相关指数(IIEF-5),同时对手术前后患者反射性勃起和心理性勃起的情况进行对比研究。结果:大多数患者术后神经功能明显好转,术后JOA评分比术前提高(13.50±1.22vs9.64±1.87,P<0.01)。正常反射性勃起手术前后比较有显著性差异(95%vs82%,P<0.05),正常心理性勃起手术前后比较有显著性差异(91%vs18%,P<0.01),术后多数患者性功能明显好转,平均IIEF-5指数由术前的9.90±2.22提高到术后的20.89±3.89,两者差异显著(P<0.01)。结论:除了神经功能障碍外,脊髓型颈椎病也可导致性功能障碍,大多数表现心理性勃起异常而反射性勃起正常。术后随着神经功能的恢复,多数患者性功能也得以好转。     

雄激素对勃起组织和性功能的影响

正常男性性功能依赖心理、神经、血管和内分泌诸因素协调作用。而在有关触发和维持勃起中哪种因素相对重要,存在较多争论,特别是睾酮的作用。来自不同的报告显示因内分泌失调而致勃起功能障碍的发生率从 １７％到 ３５％不等［３,１８］。Ｊｏｈｎｓｏｎ和Ｊａｒａｗ［４］报告一组在泌尿科门诊连续检查 ３３０例勃起功能障碍病例中,发现血浆睾酮水平不正常的比例为２．１％。然而相关文献也充分肯定雄激素对勃起功能的作用。Ｅｉｌｌｉｓ和Ｇｒｅｙｈｎｃｋ［５］报道用药物或手术方式行去势治疗晚期前列腺癌的病例中,原性功能正常的…     

计算机化性功能检查仪在男性学的临床应用

1　产生与发展由于科技之进展迅速 ,在有关男性性功能失调的检查 ,现在得以计算机化并形诸数据和图形时 ,我们必须回溯到Halverson( 1 940 )对夜间阴茎勃起之基础理论的提出 ,Ohlmeyer( 1 944)曾论述在睡眠中阴茎于眼振周期 (REM)下自然勃起的试验。此后 2 0年间在医学专家的不断探索和研究下 ,在1 965年由Jovanovic等医师的继续努力下 ,1 970年建立了“夜间阴茎勃起”功能之评估与分类 ,区分其勃起功能障碍究竟是肇因心理上的因素或是器官本身之问题 ,并开发出“夜间阴茎勃起试验仪 (NPTMonitor)”用来检查男性性功能失调的患者。但Ch…     

男性性功能障碍相关问卷的应用进展

由于男性性功能障碍发病率的升高,临床医生越来越需要准确、高效的问卷来评估治疗效果和满意度,并帮助患者达到满意的治疗结果。为此,本文总结了一些关于男性性功能障碍的常用问卷,包括勃起功能国际问卷、勃起硬度分级、勃起质量量表、勃起功能障碍治疗满意度调查表、治疗满意度量表、自尊心及性关系问卷、早泄评估表、早泄诊断工具、早泄指数量表、阿拉伯早泄指数量表、老年男性症状量表、中老年男性雄激素缺乏自测表以及迟发型(迟发性性腺功能减退)睾丸功能减退症状调查表,并对它们的临床应用进行了综述。     

十一酸睾酮胶丸和他达拉非治疗伴有睾酮水平低下的勃起功能障碍患者的疗效分析

<正>勃起功能障碍(erectile dysfunction,ED)是指阴茎持续不能达到或维持足够的勃起以完成满意的性交,是成年男性最常见的性功能障碍疾病之一,而且其发病率呈现逐年增加的趋势。ED的病因非常复杂,涉及生理性及心理性等多方面因素,因此治疗采用以药物治疗为主,以心理行为治疗为辅的综合疗法,而其中针对原发疾病的药物治疗一直占据着非常重要的位置。在临床工作中,睾酮水平低下是ED的常见病因之一,其患者年龄分布范围广,既有中老     

插入障碍的诊断和治疗(附32例临床分析)

目的 :探讨插入障碍 (IO)的诊治方法 ,并为其下一定义。　方法 :根据O’Leary男性性功能问卷的前 5项涉及性欲、勃起、插入的问题 ,设计插入自评量表 (SIS) ,对 32例IO的患者进行诊断 ,并主要以心理行为疗法对其进行治疗。　结果 :32例患者中 30例确诊为IO ,其中 2 9例为单纯性心理IO ,占 90 .6 % ,经心理行为治疗后均获得治愈 ;1例为器质性IO ,未治愈。　结论 :IO作为一种性功能障碍 ,能够通过SIS进行诊断 ,应用心理、行为疗法可获得治愈     

慢性肾功能衰竭患者性功能障碍机制的研究进展

性功能障碍在慢性肾功能衰竭患者中发病率很高,但目前在治疗效果上除了男性勃起功能障碍外均不够理想.为了取得更好的治疗效果,首先要明确性功能变化的发生机制、本文就近年来对慢性肾功能衰竭患者性功能变化的机制研究的进展作一综述.     

血液透析患者性功能障碍临床研究

目的：探讨男性血液透析患者性功能障碍的影响因素.方法：对164例维持性血液透析患者（MHD）采用自我行为量表（SCS）、抑郁自评量表（SDS）及勃起功能国际指数问卷（IIEF-5）进行问卷调查.结果：发现年龄、糖尿病和高BDI得分是独立的影响性功能障碍的指标,在性功能指标得分较低的患者其健康相关生活质量量表的各项得分也显著降低,得分均具有统计学意义.结论：男性血液透析患者性功能障碍与抑郁程度、高龄、糖尿病及生活质量均有关系.     

人工造口术后阴茎勃起功能障碍调查及西地那非治疗效果分析

行人工造口术患者不断增长，但对造口术后性功能情况的调查研究不多，对造口术后性功能障碍的治疗报道很少。我们对128例行人工造口术后的男性患者进行性功能情况调查，对部分勃起功能障碍（ED）患者予以西地那非治疗，现报告如下。     

Update on the relationship between sexual dysfunction and lower urinary tract symptoms/benign prostatic hyperplasia

PURPOSE OF REVIEW: Lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) is a condition that commonly affects older men and is often associated with sexual dysfunction. Recent evidence of an association between LUTS/BPH and sexual dysfunction will be reviewed, as well as the effects of pharmacological treatment options for symptomatic LUTS/BPH on sexual function. RECENT FINDINGS: Large-scale epidemiological studies conducted worldwide have provided strong evidence for an association between LUTS, erectile dysfunction and ejaculatory dysfunction. In multivariate analyses controlling for age, comorbidities, and lifestyle factors, LUTS have been clearly demonstrated to be an independent risk factor for erectile and ejaculatory dysfunction. Various pathophysiological mechanisms have been proposed for the association between LUTS and male sexual dysfunction. These include autonomic hyperactivity, alterations in Rho/Rho kinase pathway, endothelial (nitric oxide synthase/nitric oxide) dysfunction, pelvic ischemia, and age-related hormone imbalances. Owing to the link between LUTS/BPH and male sexual dysfunction, patients presenting with one of these conditions should be routinely screened for the other condition. In addition, because medical and surgical treatments for LUTS/BPH are commonly associated with sexual side effects, patients with LUTS/BPH should be monitored for treatment-related sexual outcomes. SUMMARY: LUTS/BPH is an independent risk factor for sexual dysfunction in aging men. Further studies are needed to define the mechanism(s) underlying the link between LUTS/BPH and male sexual dysfunction. Additional studies of combination therapy for LUTS/BPH, sexual dysfunction, and other age-associated comorbidities are needed to establish new approaches to the optimal management of these conditions in aging men.     

男性慢性肾功能不全病人的性功能障碍研究

目的 :研究四川省男性慢性肾功能不全病人性功能障碍的发病情况、表现形式和相关因素。　方法 :多中心合作、临床横断面调查 ,利用性功能电脑测评与诊断系统 (SCASF) ,对四川省 12 4例慢性肾功能不全病人和 12 5例慢性肾脏病肾功能正常病人 (对照组 )的性功能状态进行综合评价 ,同时测定其血常规、肾功能、性激素、性激素结合球蛋白等指标。　结果 :①慢性肾功能不全病人性功能障碍主要表现为性欲减退、勃起功能障碍 (ED)、早泄。②慢性肾功能不全病人性欲减退、ED、早泄、性操作焦虑、性合作缺乏的发生率明显高于对照组 (P <0 .0 5 )。③血液透析和腹膜透析病人各种形式的性功能障碍的发生率和障碍的严重程度没有差异 ;透析组 (血液透析和腹膜透析 )、未替代治疗组、肾移植组比较 ,未替代治疗组性欲减退和性操作焦虑的发生率高于透析组与肾移植组 ;未替代治疗组和透析组ED的发生率高于肾移植组。④多因素分析表明 ,性功能障碍的发生与病人的病程、肌酐清除率、甲状旁腺激素、血浆白蛋白无关。贫血、抑郁和应用 β受体阻滞剂是性欲减退的危险因素。年龄增加是ED的危险因素。应用血管紧张素转换酶抑制剂或血管紧张素受体拮抗剂和应用人基因重组促红细胞生成素 (r HuEpo)可减少ED的发生。　结论 :男性慢性     

Psychogenic erectile dysfunction. Classification and management

Psychogenic factors are involved alone or in combination with organic causes in a substantial number of cases of erectile dysfunction. Epidemiologic studies have implicated the role of depressed mood, loss of self-esteem, and other psychosocial stresses in the cause of erectile dysfunction. A new definition and classification of psychogenic erectile dysfunction has been proposed based on recent clinical and research findings. According to this new classification, psychogenic erectile dysfunction is categorized as generalized or situational type, with subcategories of each type proposed. Traditional treatment approaches for psychogenic erectile dysfunction have included anxiety reduction and desensitization procedures, cognitive-behavioral interventions, guided sexual stimulation techniques, and couples' or relationship counseling. Recently, these approaches increasingly have been combined with pharmacologic therapy such as sildenafil. Special situations have been identified in which combining psychosocial interventions with medical therapy is recommended. These situations include problems of sexual initiation, low sexual desire, other sexual dysfunctions, and significant couples' or relationship problems. More research is needed on the role of psychosocial interventions in the treatment of erectile dysfunction.     

Development of a rat model of sexual performance anxiety: effect of behavioural and pharmacological hyperadrenergic stimulation on APO-induced erections

As part of the multifactorial nature of erectile dysfunction, anxiety associated with sexual performance (SPA) remains a major contributing factor to its progression. In fact, the heightened sympathetic activity associated with sexual performance anxiety may be a key early component of this disruption of normal erectile responses. We are not aware that any animal models have been developed to assess this phenomenon. Using apomorphine (APO, 80 microg/kg s.c.)-induced erections in rats we characterised the effects of behavioural or pharmacological hyperadrenergic stimulation (that is, anxiety) on erections and hemodynamics. We developed an experimental SPA paradigm by exposing male rats to the stress of being observed by a larger, older male rat placed in close proximity to test rats during APO testing. In a separate group, adrenergic stress was simulated using a sympathomimetic, methoxamine (MXA) given prior to APO testing. In a third group, the changes in circulatory parameters (mean arterial pressure, heart rate) were determined following instrumentation with radiotelemetric transducers for each scenario. APO-induced erections were significantly lower in both the behavioural (1.25+/-0.8) and pharmacological (0.33+/-0.5) stressor paradigms compared to controls (2.81+/-0.9). Further, erections in MXA-treated rats were significantly lower than in the observed scenario. Despite the differences in erections hemodynamic assessments showed no differences in MAP or HR changes between the different experimental conditions. Thus, both the behavioural and pharmacological paradigms of SPA decreased erections, but did not affect the circulation. This suggests that the level of hyperadrenergic input required to induce erectile dysfunction can be subtle, and target only erectogenic pathways.     

Hormonal etiology in erectile dysfunction

The proper function of erection mechanisms depend on correct interrelationship between psychological, vascular, neurological and hormonal factors. Endocrine diseases affect sexual function, and sexual dysfunction may be one of the symptoms of some hormonal anomalies. Diabetes mellitus is the endocrine disease most frequently causing erectile dysfunction due to the frequent vascular and neurological complications associated. It is important to determine blood glucose in the initial evaluation of a male with erectile dysfunction, as well as to try an adequate control of blood glucose levels to avoid worsening. Diabetic male erectile dysfunction is multifactorial, more severe and has worse response to oral treatment. Hyperprolactinemia causes disorders of the sexual sphere because it produces a descent of testosterone. In these cases, sexual symptoms are treated by correcting the levels of prolactin. Routine determination of prolactin is not clear and it seems it should be determined when testosterone levels are diminished. Thyroid hormone disorders (both hyper and hypotyroidism) are associated with erectile dysfunction, which will subside in half the patients with thyroid hormone normalization. The role of adrenal hormones in erectile function is not clear and their routine determination is not considered in the diagnostic evaluation of erectile dysfunction. The role of estradiol in the regulation of the erection mechanism is not well known either, although it is known that high levels may cause erectile dysfunction. Among endocrine-metabolic disorders we point out dyslipemias, with hypercholesterolemia as an important risk factor for erectile dysfunction and, though its correction may prevent vascular system deterioration, the role of statins in erectile dysfunction is not clear.     

Erectile dysfunction

PURPOSE: Male sexual health has taken on increased importance as the United States population ages, develops coexisting medical conditions and undergoes interventions that can affect sexual function. We characterized the burden and severity of disease, treatment patterns and economic consequences of erectile dysfunction. MATERIALS AND METHODS: The analytical methods used to generate these results were described previously. RESULTS: Erectile dysfunction was self-reported by almost 1 of 5 men and it increased with age. Erectile dysfunction may have been more commonly reported in Hispanic men and in those with a history of diabetes, obesity, smoking and hypertension. In most databases black American men had rates of use for office visits and inpatient hospital care that were twice those of other racial groups, although these rates were not controlled for comorbid conditions or other regional and socioeconomic factors. The use of diagnostic tests markedly decreased, while pharmacological therapy, especially with oral phosphodiesterase-5 inhibitors, markedly increased. Penile implant surgery continued to be performed with most patients electing inflatable devices. Extrapolating from the population based estimates of erectile dysfunction prevalence and current use trends showed that the cost of treatment nationwide could reach $15 billion if all men sought treatment. CONCLUSIONS: The burden of disease due to erectile dysfunction in the United States will increase with the aging of the male population, increasing prevalence of comorbid conditions, expanded treatment seeking behavior and costs of pharmaceutical therapy. Accurate estimates of economic cost will require better understanding of pathogenesis, treatment seeking behavior, patient preference for therapies, success of treatments and relative satisfaction with oral pharmacotherapy and penile implants.     

The utility of sildenafil citrate for infertile men with sexual dysfunction: a pilot study

OBJECTIVE: To investigate the use the sildenafil citrate, recognized as a first-line therapy for men with erectile dysfunction (ED), and which is safe and effective in men with various causes and severity of ED, including psychogenic ED, in a population of infertile men with sexual dysfunction. PATIENTS AND METHODS: Infertility is a major source of life stress and might be associated with sexual dysfunction through the erosion of self-esteem and self-confidence, and in stimulating discord in a relationship. Men presenting for evaluation of fertility who on questioning by the physician reported the recent onset of sexual dysfunction, had a history taken, a physical examination, hormonal profile, and completed the International Index of Erectile Function (IIEF), a validated inventory for assessing sexual dysfunction. Thirty men with a score of <26 on the erectile function domain of the IIEF, or who complained of new onset rapid or delayed ejaculation, were treated with sildenafil with no randomization or placebo control. The evaluation was repeated and the IIEF completed again > or =3 months after starting treatment. RESULTS: For men complaining of ED, subjective erectile rigidity, duration of erection, and the percentage of successful penetration attempts significantly improved with sildenafil. The mean (sd) IIEF domain scores for erection and satisfaction, at 18 (4) vs 27 (3), and 12 (2) vs 16 (3) (both P = 0.01), and orgasm, at 4 (1) vs 6 (3) (P = 0.001), respectively, significantly improved after treatment. In patients with ejaculatory dysfunction, the function improved in 64% after sildenafil therapy. CONCLUSIONS: We identified the nature of sexual dysfunction associated with male-factor infertility, and showed the efficacy of sildenafil therapy in men with this condition.     

Effect of new oral direct acting antiviral therapy on sexual function in male patients with hepatitis C virus

Hepatitis C virus (HCV) infection is a major health problem all over the world including Egypt. Chronic HCV infection is usually accompanied by decrease of libido and erectile dysfunction. This study aimed to evaluate the efficacy of new oral direct acting antiviral (DAA) therapy on sexual function of male patients with HCV. This study was conducted on 200 male participants divided into two groups, first group included 100 male patients with HCV and the second group included 100 healthy age matched males as a control. Patients received DAA for three months and virological free status was confirmed by polymerase chain reaction. All participants were subjected to full history taking, general examination and local genital examination, assessment of sexual function by a validated Arabic version of the international index of erectile function-5. Laboratory investigations included liver functions serum testosterone, free testosterone, sex hormone-binding globulin and bioavailable testosterone. Results of this study showed that patients with HCV suffer from sexual dysfunction than controls that significantly improved after DAA therapy, and this is accompanied by increasing of bioavailable testosterone. It could be concluded that beside its effectiveness in treatment of HCV infection, DAA therapy can improve sexual function in male patients with HCV.     

Andrology in China： current status and 10 years＇ progress

Andrology has a long history in traditional Chinese medicine. There are records of male sexual health, male sexual dysfunction and male infertility from over thousands of years ago. Modern andrology in China had a late start, with the Chinese Andrology Association founded in 1995. Within last decade, andrology in China has grown rapidly. In this review article, we summarized the progress of andrology in last 10 years and outlined the current status of Chinese andrology with a special focus on progress in male erectile dysfunction, prostate diseases, male infertility and male hormonal contraception.     

Treatment of premature ejaculation after traumatic brain injury

Premature ejaculation (PE) is the most common male sexual disturbance occurring in the general community. Surveys of sexual dysfunction after traumatic brain injury (TBI) have identified that between 17-36% of males report a number of different post-injury ejaculatory problems, including PE. Whilst there are a number of studies that document effective treatment of PE in the general population, there have been no reports of treatment interventions for this problem amongst males with TBI. This paper reports on the assessment and successful treatment of PE in a young male with severe TBI. The treatment programme trialed combined pharmacotherapy (namely, the application of a topical anaesthetic), behavioural and educational approaches. The case report suggests that existing sex therapy techniques, albeit with modifications to compensate for motor sensory, cognitive and affect related injury sequelae, provide one option for the treatment of PE after TBI.